Following God Against the Flow

I have five children.  In some circles, that’s not many.  But among the general population, that’s a LOT.  The journey to this point in my life has been interesting and, without fail, a walk of faith.  Let me start with a little history.

My husband and I met in 1995. We worked together at an animal emergency clinic. Love at first sight sounds pretty corny, but I did know he was the one when I first met him. We became friends and started dating. We were engaged within a few months. I guess most couples talk about how many kids they want. At least we did. He wanted 10. I gagged and told him to take a hike. 

We conceived our first baby about three months after our wedding, but I miscarried at 7 weeks. We were heartbroken.  It took a year to conceive again, and our first daughter was born. I swore it would be my last. Why in the world would anyone do that multiple times?  But within a few weeks, I realized that no feeling in the world matched the love a parent has for a baby. I decided that maybe one more might be okay, but we decided to wait a few years so I could finish graduate school. 

So, being the OCD individual that I am, I planned my next pregnancy to coincide closely with my graduation. That didn’t work, and I miscarried again at 8 weeks. This miscarriage was even more emotionally wrenching than the first. So many women told me their miscarriage story that I had kind of made it a rite of passage. So, I had my obligatory miscarriage, and now I didn’t have to worry about another one. Right? Not exactly. If a second miscarriage did anything, it was to harden my resolve to have another child. I conceived within a few months and was four months pregnant at my graduation.

This pregnancy wasn’t quite as easy. I was sick through much of it. The cough from an upper respiratory infection during the first trimester made a muscle in my back feel like it was being ripped out. Then, I had the flu around month five. The end of the pregnancy couldn’t come fast enough. The bright spot was a delivery that couldn’t have been any easier.

To most people, I almost had the perfect family now. Well, they were both girls, so I could get a pass for one more try for that boy that everyone supposedly needs. We decided to not use birth control any more, but not because we wanted a boy. We have strong convictions about abortion and after researching the effects of the birth control pill could see where it only partially prevented pregnancy. Secondarily, the pill creates an environment that tries to prevent a fertilized egg from implanting. In our view, life begins at conception. Anything that actively prevents the normal progression of a pregnancy is abortion.

So, I conceived a fifth time and knew almost immediately I was in for another miscarriage. I had come to know the signs of a “good” pregnancy vs. a “bad” pregnancy. At least for me, I did not get sick when the pregnancy wasn’t going well. While no one enjoys morning sickness, it is a welcome sign of the body’s hormonal preparation to grow a baby. If my hormones didn’t go wacko, there was nothing to be done. At nine weeks, there was no heartbeat, and I began spotting. There was an emotional difference about this miscarriage, though. I just had a peace. I knew I was going to miscarry. There was grief for the child we would not hold, but not the turmoil of unanswered questions. God was in control and knew best.

Pregnancy number six followed closely again, and you guessed it, another girl. We could not have been happier, but there was a lot of eye rolling going on. Since she was born shortly after my 40th birthday, most people assumed we were done. How they arrived at that assumption is a mystery to me. I never said we were done. My husband never said we were done. But, in their infinite wisdom, family and friends pronounced us “done.”

Indeed, I didn’t conceive again for more than three years. We held our breath to see if this was good or bad pregnancy. Morning sickness hit full force quickly, and we exhaled in relief. This pregnancy was hardly normal, though. I quickly retained copious amounts of fluid and experienced extreme fatigue. By the middle of the seventh month, I couldn’t wear regular shoes. I was out of breath walking across the room. My OB, who has treated me since pregnancy #2, ordered extra tests and sonograms to see if anything was wrong. He looked for blood clots in my leg when one swelled four times its normal size. Everything came back normal. We erroneously assumed it was due to an unusually hot season. Since, it’s always hot in Texas, unusually hot is, well, really really hot.

Finally, we scheduled an induction because this pregnancy just had to come to an end. The delivery had a few hiccups, but nothing that indicated the seriousness of what was coming. I was discharged on Thanksgiving Day feeling more awful than when I had arrived. I could barely hold the baby. My milk did not come in. I could sleep for hours and feel more tired than when I laid down. Then, I developed a cough. A cough unlike any cough I have ever had. First, I could only sleep propped up, but within a few days I had to stoop over to breathe. Two weeks post-partum, I started coughing during the night and couldn’t stop. I couldn’t catch my breath. I collapsed on the floor in front of my husband and children. I thought I must have pneumonia. We all dressed and went to the emergency room thinking I would get some antibiotics, a breathing treatment and come home. Yes, we walked into an ER with four children, including a newborn (a girl, in case you’re wondering), thinking this was nothing more than a pit stop.

The medical staff took one look at me and had me in a room immediately. I had a chest x-ray that showed vast amounts of fluid in my lungs and an enlarged heart. The doctor came to me and said, “You’re not going anywhere tonight or tomorrow and probably not the next day. A cardiologist is on his way.” This was much worse than pneumonia and definitely not a pit stop. The cardiologist walked in and said, “You have peripartum cardiomyopathy. You’d better be glad you came in tonight. You wouldn’t have lived to see a doctor tomorrow. Oh, and by the way, you can never get pregnant again.” Gee, good morning to you, too.

Peripartum cardiomyopathy (PPCM) is a very rare pregnancy complication. So rare, that many doctors have only read about it in medical journals. My OB has been practicing for 30 years and is a top notch doctor. I am only his second patient to have this complication. Symptoms closely mimic regular end-of-pregnancy symptoms. Who doesn’t look like a balloon and have trouble breathing at nine months? Therefore, by the time PPCM is diagnosed, a patient is often in severe distress, such as myself. I’ve read stories of women who collapsed in cardiac arrest and one recently who had a heart transplant. It really is that serious.

An echocardiogram confirmed the diagnosis of congestive heart failure and severe PPCM, and every doctor, nurse, nurse’s aide, and cleaning woman told me to never get pregnant again. All right, already. I left the hospital four days later minus more than two liters of fluid. I looked almost gaunt compared to my pregnancy weight. But with less than half my heart function, I still felt better than before. I’m not sure how to explain our emotions during this time. Numb, maybe. Some say I cheated death, but I know I was spared by the hand of God.

Recovery estimates for PPCM vary because there is very little research on the phenomenon. The doctors were optimistic I would recover some heart function within a year. After a lot of my own research online (every doctor’s nightmare), I found a survivor’s support group, A Mother’s Heart. A doctor affiliated with the group regularly posts new findings and helps survivors understand a lot of the medical gibberish we get from our doctors. He also has compiled updated research information for survivors to give to their doctors. Understandably, the doctor’s philosophy is, “If I don’t know what causes it or have a good way to control it, I avoid it at all costs.” Therefore, their pat answer for PPCM is to avoid pregnancy altogether. One cardiologist even point blank asked me who was getting “fixed”, me or my husband.

This was a big decision, even at my “advanced maternal age.” We understood the implications of getting pregnant, and quite honestly, I was too sick to have to worry about it for a while. I scheduled a follow-up two months after my initial diagnosis. The doctor repeated the echo and a CAT scan. A few days before the appointment, I was really struggling with some decisions. I was opposed to the pill and an unsuitable candidate for a tubal ligation, and my husband was opposed to a vasectomy. So, what could we do long term?

Obviously, this was a real crossroads for both of us, but for me, in particular. So, the day before my follow-up visit with the cardiologist, I told God that I trusted Him. I meant it in a different way this time. If I recovered from the heart failure, I would trust God with the size of my family. No more birth control. Period. While I stood a higher than average chance of relapsing with another pregnancy, the odds were still pretty long. In other words, doctors estimate PPCM to occur in 1 in 2,000 to 4,000 pregnancies. A woman with a history of PPCM has an estimated 30% higher chance of PPCM complications. I’m not a mathematician, but that still sounds like pretty long odds, especially if you’re looking for the signs and controlling what you can control.

At the doctor’s office the next day, the cardiologist walked in and unceremoniously told me I had completely recovered. Normal heart function. No lasting damage. Good as new. As long as I didn’t get pregnant again. He discontinued several of my medications, but left me on a beta blocker and ace inhibitor for blood pressure control. I was to return in six months for a follow up. Well, you guessed it. In five months, I was pregnant. I had never gotten pregnant so quickly, and we were still practicing “safe sex” until I was through with all the medications. It was undeniably the hand of God. When you make a promise, He takes you at your word.

I discontinued the ace inhibitor, which causes severe deformities, and called my OB. I didn’t dare go back to the cardiologist I had seen before and made an appointment with the doctor I had seen in the ER. He seemed like a more reasonable and knowledgeable guy. My OB, who we consider a trusted friend after seven pregnancies, is one cool cucumber, but his normally calm façade cracked when I told him I was pregnant again. He expressed sincere concern for my health and the outcome of the pregnancy.

During a series of appointments with him, the new cardiologist, and a maternal fetal specialist, we heard numerous gloomy predictions and plans of treatment. Our first goal was to reach 28 weeks, which seemed likely since PPCM typically occurs during the third trimester. Then, 33 weeks became the goal, and finally 40 weeks was in sight. Unbelievably, I had made it through the entire pregnancy with barely any swelling or other concerns. An echo at the beginning of each trimester showed full heart function.

We could see the light at the end of the tunnel right about now. Only one problem. This child would not be still, and she (yes, girl #5) really preferred to lie crossways. Transverse, if you insist on proper medical terminology. This presented a problem. If my water broke, the umbilical cord could fall through the cervix (prolapse) and cut off the blood and oxygen supply to the baby, killing her in a matter of minutes. We opted to try an external aversion (move her head down) and induce at 39 weeks. I had induced several times for various reasons, so I didn’t see a problem with this. We were very optimistic that she would be cooperative. Boy, were we wrong. She moved into place quite easily, but after about four hours of pitocin (a slow drip, since this was my fifth delivery), she started showing signs of distress.

Our nurse became concerned and called the doctor. He had been watching the monitor, too, and came straight over. Though the nurse had just checked my progress and told him I was dilated to an 8, he decided to check again. The cord had prolapsed and was pinched between my pelvis and the baby’s head. Everyone suddenly switched into overdrive. A nurse jumped on the bed with me and pushed her hand up against the baby’s head to keep it off the umbilical cord. The monitors were ripped off, and we headed to the operating room at a dead run, well I was actually being pushed in the bed. There is a point beyond terrified where your mind just kind of shuts down. That’s where I was. I could actually hear the conversation between the nurses, but since there was a lot of yelling, it would have been hard not to hear them.  Thankfully, the emergency cesarean was a success. Though her first APGAR was a 2 (all she had was a heartbeat), she quickly recovered to a good 7 (good response, color, and cry). I took quite a bit longer to recover, but it wasn’t nearly as bad as I thought it would be.

We were so thankful and humbled by God’s obvious intervention. From the beginning, God was determined to achieve his plan. How could I get pregnant when we were being careful to avoid a pregnancy? Why did I get pregnant at age 44 only five months post-partum when all my other children were at least two years apart? Why did I have an easy pregnancy with no complications when the doctors were convinced I would die? What would have happened if the doctor had been even a few minutes later after the cord prolapsed? I don’t know the answer to any of these questions, except that nothing thwarts God’s plan when you are yielded to his will.

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